treatment

Last reviewed 03/2023

Spontaneous repair of the meniscus, unless the lesion is peripheral, is unlikely to occur. This is because the meniscus is avascular.

Treatment of meniscal tears depends on several factors e.g. - type, location, and size of the tear. Treatment options include:

  • conservative treatment without meniscal surgery
    • considered initially in all patients regardless of whether surgery is being considered
    • RICE (Rest with weight bearing as tolerated or with crutches, Ice, Compression bandaging, Elevation of the affected limb to minimise acute swelling and inflammation) regimen should be followed  
    • activity modification, NSAID’s (if contraindicated or poorly tolerated consider paracetamol) and physiotherapy should be included in long term management (1)
  • complete meniscectomy
    • not a common procedure at present
    • has been shown to be associated with accelerated cartilage loss and development of osteoarthritis
  • partial meniscectomy
    • is indicated when meniscal repair is not possible (3)
    • only the unstable tissue is removed while preserving as much of the meniscus as possible (especially the outer third)
    • causes less damage to the joint when compared with complete menisectomy
    • is the preferred treatment method in patients with unstable tears (when primary meniscal repair is not possible) (2)
  • meniscal repair
    • aim is to maintain meniscal integrity and prevent long-term degenerative changes seen after meniscectomy
    • usually carried out in tears in the vascularised outer third of the meniscus (termed the ‘red-red zone’ signifying the area of vascularity) while repair of tears in red-white zone’ (watershed area between vascular and avascular meniscus) is controversial. ‘White-white zone’ (avascular zone) tears are repaired rarely
    • techniques include - open repair, arthroscopic inside out repair, arthroscopic outside in repair, arthroscopic all inside repair (3)
    • patients are kept on non or partially weight bearing for several weeks
    • healing takes around 4 months after which the patients are usually asymptomatic
    • a favourable repair outcome is seen in
      • surgery done within 8 weeks of injury
      • patient age under 30 years
      • tear length less than 2.5 cm
      • a peripheral tear
      • a lateral meniscus tear
      • concomitant ACL reconstruction
  • meniscal transplant
    • could be considered for selected patients who have undergone previous complete or near-complete menisectomy

In the case of bucket-handle tears, excision of the meniscus may be enough to reduce any risk of secondary osteoarthritis.

An important feature of treatment is postoperative physiotherapy.

Reference:

Related pages:

returning to work following partial meniscectomy